Human Umbilical Cord Mesenchymal Stem Cells for Severe Neurological Sequelae due to Anti-N-Methyl-d-Aspartate Receptor Encephalitis: First Case Report

• Published in: Cell transplantation Vol. 31; pp. 96368972211108 - 9636897221110876
• Main Authors: Nguyen Thanh, Liem, Hoang, Van T., Le Thu, Huong, Nguyen, Phuong Anh Thi, Hoang, Duc M., Ngo, Doan Van, Cao Vu, Hung, Nguyen Thi Bich, Van, Heke, Michael
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 2022; Sage Publications Ltd
• Subjects: Atrophy; Case reports; Case Study; Cell therapy; Cognition; Encephalitis; Glutamic acid receptors; Glutamic acid receptors (ionotropic); Immunoglobulins; Intravenous administration; Magnetic resonance imaging; Mesenchymal stem cells; N-Methyl-D-aspartic acid receptors; Neuroimaging; Neurological complications; Stem cells; Stromal cells; Umbilical cord; autoimmune encephalitis; neurological sequelae; anti-NMDA receptor encephalitis; mesenchymal stem cells; mesenchymal stromal cells
• ISSN: 0963-6897; 1555-3892
• DOI: 10.1177/09636897221110876

Anti-N-methyl- d -aspartate (NMDA) receptor encephalitis is caused by altered patient immune reactions. This study reports the first patient with severe neurologic sequelae after NMDA receptor encephalitis treated with allogeneic umbilical cord–derived mesenchymal stem/stromal cells (UC-MSCs). A 5-year-old girl was diagnosed with NMDA receptor encephalitis and treated with immunosuppressive medicaments and intravenous immunoglobulin (IVIG). Despite intensive therapy, the patient’s condition worsened so that allogenic UC-MSC therapy was contemplated. The patient received three intrathecal infusions of xeno- and serum-free cultured UC-MSCs at a dose of 106 cells/kg. At baseline and after each UC-MSC administration, the patient was examined by the German Coma Recovery Scale (CRS), the Gross Motor Function Classification System (GMFCS), the Gross Motor Function Measure–88 (GMFM-88), the Manual Ability Classification System (MACS), the Modified Ashworth Scale, and the Denver II test. Before cell therapy, she was in a permanent vegetative state with diffuse cerebral atrophy. Her cognition and motor functions improved progressively after three UC-MSC infusions. At the last visit, she was capable of walking, writing, and counting numbers. Control of urinary and bowel functions was completely recovered. Cerebral atrophy was reduced on brain magnetic resonance imaging (MRI). Overall, the outcomes of this patient suggest a potential cell therapy for autoimmune encephalitis and its neurological consequences.